Healthcare Provider Details

I. General information

NPI: 1922193937
Provider Name (Legal Business Name): WILLIAM EUGENE FOOTE IV DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S CHERRY ST
HAMBURG AR
71646
US

IV. Provider business mailing address

201 S CHERRY ST
HAMBURG AR
71646
US

V. Phone/Fax

Practice location:
  • Phone: 870-853-4486
  • Fax: 870-853-4486
Mailing address:
  • Phone: 870-853-4486
  • Fax: 870-853-4486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3255
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: